From the Research
A thumb spica splint is the recommended splint for de Quervain tenosynovitis, as it immobilizes the thumb and wrist while leaving the fingers free to move, which helps rest the inflamed abductor pollicis longus and extensor pollicis brevis tendons. This recommendation is based on the most recent and highest quality study available, which compared the efficacy of thumb spica casting with or without corticosteroid injection for De Quervain's tenosynovitis 1. The study found that the combined approach of thumb spica casting and corticosteroid injection led to significantly better pain relief and functional outcomes compared to casting alone.
Key Points to Consider
- The splint should be worn continuously for 2-6 weeks, removing it only for hygiene purposes.
- For optimal results, the splint should position the wrist in slight extension (about 15 degrees) and the thumb in slight abduction.
- Patients should be instructed to avoid activities that involve repetitive thumb and wrist movements, particularly those combining forceful gripping with ulnar deviation of the wrist.
- The splint works by reducing inflammation by preventing movement of the affected tendons through the narrow fibro-osseous canal, allowing the inflammation to subside.
- This conservative treatment is often combined with NSAIDs and, in some cases, corticosteroid injections for more effective pain relief and reduction of inflammation.
Evidence-Based Recommendation
The recommendation for using a thumb spica splint is supported by multiple studies, including a systematic review and network meta-analysis that found that adding a short period of thumb spica immobilization to corticosteroid injection was associated with statistically significant short- and mid-term benefits 2. Another study found that the combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes 3.
Important Considerations
- If symptoms persist after 4-6 weeks of splinting, reassessment and consideration of other treatment options may be necessary.
- The use of a thumb spica splint should be individualized based on the patient's specific needs and circumstances.
- Patients should be educated on proper splint use and care to ensure optimal outcomes.